Phlebotomy-free days in children hospitalized with common infections and their association with clinical outcomes.

Creator(s)

Megan Collins, Children's Mercy Kansas CityFollow
Matt Hall
Samir S. Shah
Matthew J. Molloy
Paul L. Aronson
Jillian M. Cotter
Michael J. Steiner
Elisha McCoy
Michael J. Tchou
John R. Stephens
Jessica L. Markham, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

4-2024

Identifier

DOI: 10.1002/jhm.13282

Abstract

BACKGROUND: Phlebotomy for hospitalized children has consequences (e.g., pain, iatrogenic anemia), and unnecessary testing is a modifiable source of waste in healthcare. Days without blood draws or phlebotomy-free days (PFDs) has the potential to serve as a hospital quality measure.

OBJECTIVE: To describe: (1) the frequency of PFDs in children hospitalized with common infections and (2) the association of PFDs with clinical outcomes.

DESIGN, SETTINGS AND PARTICIPANTS: We performed a cross-sectional study of children hospitalized 2018-2019 with common infections at 38 hospitals using the Pediatric Health Information System database. We included infectious All Patients Refined Diagnosis Related Groups with a median length of stay (LOS) >2 days. We excluded patients with medical complexity, interhospital transfers, those receiving intensive care, and in-hospital mortality.

MAIN OUTCOME AND MEASURES: We defined PFDs as hospital days (midnight to midnight) without laboratory blood testing and measured the proportion of PFDs divided by total hospital LOS (PFD ratio) for each condition and hospital. Higher PFD ratios signify more days without phlebotomy. Hospitals were grouped into low, moderate, and high average PFD ratios. Adjusted outcomes (LOS, costs, and readmissions) were compared across groups.

RESULTS: We identified 126,135 encounters. Bronchiolitis (0.78) and pneumonia (0.54) had the highest PFD ratios (most PFDs), while osteoarticular infections (0.28) and gastroenteritis (0.30) had the lowest PFD ratios. There were no differences in adjusted clinical outcomes across PFD ratio groups. Among children hospitalized with common infections, PFD ratios varied across conditions and hospitals, with no association with outcomes. Our data suggest overuse of phlebotomy and opportunities to improve the care of hospitalized children.

Journal Title

J Hosp Med

Volume

19

Issue

4

First Page

251

Last Page

258

Recommended Citation

Collins ME, Hall M, Shah SS, et al. Phlebotomy-free days in children hospitalized with common infections and their association with clinical outcomes. J Hosp Med. 2024;19(4):251-258. doi:10.1002/jhm.13282